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Relationship between bacterial flora in sputum and functional
impairment in patients with acute exacerbations of COPD. Study Group of
Bacterial Infection in COPD.
Autor – Miravitlles M; Espinosa
C; Fernandez-Laso E; Martos JA; Maldonado JA; Gallego M
Zeitschrift/Erscheinungsdatum –
Chest 1999 Jul;116(1):40-6.
STUDY OBJECTIVES:
To investigate the possible relationship between functional respiratory
impairment measured by FEV1 and isolation of diverse pathogens in the
sputum of patients with exacerbations of COPD. DESIGN: Multicenter, cross-sectional,
epidemiologic study. SETTING: Pneumology units in six secondary or tertiary
hospitals in Spain. PATIENTS: Ninety-one patients with acute exacerbation
of COPD were included. INTERVENTIONS: A quantitative sputum culture was
performed, and bacterial growth was considered significant only when the
germ was isolated at concentrations > 10(6) cfu (> 10(5) for Streptococcus
pneumoniae) in samples with < 10 epithelial cells and > 25 leukocytes
per low magnification field (x 100). RESULTS: Germs isolated were the
following: Haemophilus influenzae (20 cases; 22%), Pseudomonas aeruginosa
(14 cases; 15%), S. pneumoniae (9 cases; 10%), Moraxella catarrhalis (8
cases; 9%), other gram-negative bacteria (7 cases; 7%), and non-potentially
pathogenic microorganisms (non-PPMs; 33 cases; 36%). P. aeruginosa and
H. influenzae were isolated more frequently among the patients with FEV1
< 50% than among those with FEV1 > 50% (p < 0.05). All patients
with P. aeruginosa in sputum had FEV1 < 1,700 mL. FEV1 < 50% was
associated with a very high risk of P. aeruginosa or H. influenzae isolation:
the odds ratios (ORs) are 6.62 (95% confidence interval [CI], 1.2 to 123.6)
and 6.85 (95% CI, 1.6 to 52.6), respectively. Furthermore, active tobacco
smoking was associated with a high risk of H. influenzae isolation (OR,
8.1; 95% CI, 1.9 to 43.0). CONCLUSIONS: Patients with the greatest degree
of functional impairment, as measured by their FEV1, presented a higher
probability of having an isolation of P. aeruginosa or H. influenzae in
significant concentrations in sputum during an exacerbation. The diagnostic
yield of sputum in patients with an FEV1 > 50% was low, with a predominance
of non-PPMs. Low FEV1 and active tobacco smoking are data that should
be considered when establishing an empiric antibiotic treatment for exacerbated
COPD.
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